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Centrally Sponsored Scheme of Quality Control of Ayurveda - amam ...

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PROFORMA -2<br />

PROFORMA OF APPLICANT FOR CENTRAL ASSISTANCE FOR RELEASE OF<br />

GRANTS AS REIMBURSEMENT OF EXPENDITURE INCURRED BY STATE<br />

DIRECTORATE OF ISM&H/STATE LICENSING AUTHORITIES FOR<br />

TESTING OF AYURVEDA, SIDDHA, UNANI AND HOMOEOPATHY<br />

DRUGS SAMPLES THROUGH NABL ACCREDITED/ OTHER APPROVED<br />

LABORATORIES FOR TESTING OF HEAVY METALS/PESTICIDE<br />

RESIDUE/ MICROBIAL LOAD/ IDENTIFICATION OF INGREDIENTS ETC.<br />

1. Name and address <strong>of</strong> the State<br />

Government/Directorate <strong>of</strong> ISM&H<br />

(alongwith tel., fax nos.)<br />

OR other institution:<br />

(Attach detail regarding the State<br />

Drug Licensing Authority/Drug<br />

<strong>Control</strong>ler/Drug Inspector for<br />

enforcement <strong>of</strong> ASU&H provisions)<br />

2. Name <strong>of</strong> the Laboratory (with<br />

complete address)<br />

3. No. <strong>of</strong> Samples tested –<br />

<strong>Ayurveda</strong>/Unani/Siddha/Homeo-pathy<br />

4. Types <strong>of</strong> tests like heavy metals i.e.<br />

arsenic/cadmium/mercury/lead<br />

etc./pesticide residue/ identification<br />

test etc.<br />

5. Rates <strong>of</strong> per sample<br />

Total Charges <strong>of</strong> tested samples<br />

6. Requirement <strong>of</strong> funds from Central<br />

Government (please use separate<br />

sheet)<br />

7. Total fund requirement from Central<br />

Government for testing <strong>of</strong> samples <strong>of</strong><br />

<strong>Ayurveda</strong>, Unani, Siddha and<br />

Homeopathic drugs from NABL<br />

accredited/approved laboratories.<br />

8. Whether any assistance has been<br />

received from Central Government<br />

under this <strong>Scheme</strong>/any other<br />

Department <strong>of</strong> Central/State/ UT<br />

Government for similar scheme. If so,<br />

please specify and attach a certificate.<br />

5

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